Rachel E. Salas, MDa, Charlene E. Gamaldo, MD.
The hospital is not conducive to sleep. Patients commonly
recount major issues with sleep initiation and poor sleep quality during their
hospital stay. Moreover, patients in the ICU are particularly susceptible to
sleep disruption secondary to environmental and medical issues. Despite the
frequency of sleep disruption in the ICU, the quality of critically ill
patients’ sleep is often overlooked. When questioned following discharge from
the ICU, patients frequently report the occurrence of sleep disruption during their
stay, suggesting that sleep disruption in the ICU is widespread. Disturbed sleep
patterns result in the undesirable consequences of daytime sleepiness,
lethargy, irritability, confusion, and poor short-term memory. The potential
negative neurologic sequelae from sleep loss may often lead to additional tests
to evaluate for change in mentation (eg, frequent neurologic checks, head CTs,
or MRIs), potentially resulting not only in an increased financial burden to an
already strained health care system but also in extended hospital stays.
Patients requiring additional work-up because of their sleep-related change in
alertness are less able to receive the care and services, such as physical and
occupational therapy, that benefit timely discharges. In fact, increasing
evidence supports the concept that
sleep disturbance in the ICU can affect patient mortality
during hospitalization and after discharge from the unit. The level of impact
of the ICU experience on a patient seems to be multifactorial; hence, this
article discusses the following issues essential to
understanding the factors associated with sleep loss in the ICU: (1) core
elements to consider from the baseline sleep history, (2) impact of the ICU
environment on the ICU patient’s sleep pattern, and (3) overall systematic
impact of sleep deprivation on the ICU patient.
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